Consent for Treatment Under Conscious Sedation
- Conscious sedation will involve the placement of a cannula and the use of midazolam. I understand that, additionally, the corresponding procedure will use local anaesthetics.
- I confirm that the treatment has been explained to me by the dentists involved, that I have had the opportunity to ask questions, and that I am aware that the procedure is in my best interest.
- I have received advice and indications to follow before and after the treatment.
- I agree with the treatment proposed by the Doctor, the use of conscious sedation and local anaesthetic.
- I understand I may withdraw my consent at any time.
- I understand that there may be a slight variation in treatment during sedation. As the treatment will be in my best interests, I agree to this variation, as I will not be able to agree to it whilst under the influence of the sedatives.
- I understand that cancellation charges may apply:
- 50% of the sedation price will apply for cancellations within the last seven days and more than 48 hrs before the appointment.
- 100% of the sedation price will apply if the treatment is not undertaken on the day of the appointment or is cancelled within the last 48 hours.